An abundant and growing supply of digital health applications (apps) exists in the commercial tech-sector, which can be bewildering for clinicians, patients, and payers. A growing challenge for the health care system is therefore to facilitate the identification of safe and effective apps for health care practitioners and patients to generate the most health benefit as well as guide payer coverage decisions. Nearly all developed countries are attempting to define policy frameworks to improve decision-making, patient care, and health outcomes in this context. This study compares the national policy approaches currently in development/use for health apps in nine countries. We used secondary data, combined with a detailed review of policy and regulatory documents, and interviews with key individuals and experts in the field of digital health policy to collect data about implemented and planned policies and initiatives. We found that most approaches aim for centralized pipelines for health app approvals, although some countries are adding decentralized elements. While the countries studied are taking diverse paths, there is nevertheless broad, international convergence in terms of requirements in the areas of transparency, health content, interoperability, and privacy and security. The sheer number of apps on the market in most countries represents a challenge for clinicians and patients. Our analyses of the relevant policies identified challenges in areas such as reimbursement, safety, and privacy and suggest that more regulatory work is needed in the areas of operationalization, implementation and international transferability of approvals. Cross-national efforts are needed around regulation and for countries to realize the benefits of these technologies.
The Heideggerian strand of organization studies has highlighted important aspects of organizational practices. Because of the emphasis of the practice-oriented approach on routine practice, researchers have taken a special interest in how innovative, improvised action arises. One of the dominant views is that innovative action is the outcome of different variations in everyday practices. Insightful though these studies are, they do not recognize the role of the body in their conceptualization. This article seeks to redress this imbalance by drawing on Merleau-Ponty’s (1962) phenomenology, suggesting that the body, as a carrier of practices, is the locus of innovative action. The article proposes that innovative action emerges in our bodily expressive-responsive skilful coping mode. In illustrating this argument, we make use of case study material focusing on practices involving elderly care service provision. We show how the care workers under consideration cope with the demands of their unpredictable work by adapting their bodily expressive-responsive abilities innovatively to emerging situational calls. Practice innovation emerges as the outcome of a tension between what it makes sense for the care workers to do based on the practical intelligibility underlying their own practices, on the one hand, and bureaucratic rules and requirements inscribed in terms of economic rationality and cost-efficiency, on the other. Because bureaucratic rules are perceived as alienating and unethical, innovation would inevitably be a form of resistance. The article specifies this form of practical resistance, concluding with some implications of this approach for organization studies.
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